Credit Card Authorization
AUTHORIZE TM MEDIA CORPORATION
PRINT Name as it appears on Credit Card
TO CHARGE MY CREDIT CARD
Card # Exp
_______________ FOR THE AMOUNT OF $__________.
Address: Street Address City State Zip
This credit card charge covers payment for my specific
advertising request below:
Type of Ad: STANDARD THUMB OTHER _________________________
Time Contracted: ____________ Beginning Date _____________ Ending Date ___________________
Ad Rate: ______________________
I AUTHORIZE TM Media to charge my above credit card on
the ________ day of every __________
for the amount of $_____________________
to cover my advertising fees for the above ad request
until further notice.
I understand these charges made to my credit card will
cover the required fees pertaining to the ad creation & ad placement on
Thatmall.com Website ONLY. If for any reason, I decide to discontinue my “Ad
Run” on Thatmall.com, I understand all “frequency discounts” I may have earned
will be prorated to reflect the actual time period my ad ran. I also understand
all payments are final once my ad run begins, and, all ad cancellations for any
reason will be entitled to “Time” credit ONLY!
Please keep my Signature/Credit Card
Info on file for future Advertising Requests.
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